Paracoccidioidomicose é esporotricose associada à imunossupressão

Paracoccidioidomycosis is caused by Paracoccidioides brasiliensis, a dimorphic fungus, prevalent in tropical and subtropical America. It is rare in the United States of America, Canada, Asia and Europe and in these countries it is related to immigrants from endemic areas. Paracoccidioidomycosis associated with immunosuppression runs a course with rapid progression and dissemination of the disease, with many cutaneous lesions. The mortality rate is up to 35% when associated with HIV infection or AIDS. The diagnosis depends on visualization of the agent through direct examination, histopathology, or culture. First choice treatment is done with Amphotericin B deoxycholate. Itraconazole is an option for long term treatment. Sporotrichosis is caused by Sporothrix schenckii, the species of reference. Other species have been considered such as: Sporothrix brasiliensis, S.globosa and S.mexicana and the S.schenckii var. lurei. It is a ubiquitous disease although more prevalent in tropical and subtropical areas. Currently, it has been reported as a zoonotic disease of cats and dogs, with transmission to their owners in the city of Rio de Janeiro (Brazil). Sporotrichosis associated to immunosuppression is uncommon or underreported. There were 34 cases in association with HIV infection or AIDS reported so far. Presenting with disseminated disease and non cutaneous lesions including joints, lungs and central nervous system. Amphotericin B deoxycholate is the first choice for treatment and itraconazol considered an alternative.

Late-onset sepsis: Epidemiology, evaluation, and outcome

Late-onset neonatal sepsis is a common serious problem in preterm infants in neonatal intensive care units. Diagnosis can be difficult because clinical manifestations are not specific and none of the available laboratory tests can be considered an ideal marker. For this reason, a combination of markers has been proposed. Complete blood count and acute-phase reactants evaluated together help in diagnosis. C-reactive protein is a specific but late marker, and procalcitonin has proven accurate, although it is little studied in newborns. Blood, cerebrospinal fluid, and urine cultures always should be obtained when late-onset sepsis is suspected. Blood culture, the gold standard in diagnosis, is highly sensitive but needs up to 48 hours to detect microbial growth. Various cytokines have been investigated as early markers of infection, but results are not uniform. Other diagnostic tests that offer promise include: neutrophil surface markers, granulocyte colony-stimulating factor, toll-like receptors, and nuclear factor kappa B. The greatest hope for quick and accurate diagnosis lies in molecular biology, using real time polymerase chain reaction combined withDNAmicroarray. Sepsis and meningitis may affect both the short- and long-term prognosis for newborns. Mortality in neonatal meningitis has been reduced in recent years, but short-term complications and later neurocognitive sequelae remain. Late-onset sepsis significantly increases preterm infant mortality and the risk of cerebral lesions and neurosensory sequelae, including developmental difficulties and cerebral palsy. Early diagnosis of late-onset sepsis contributes to improved neonatal prognosis, but the outcome remains far from satisfactory. © 2010 by the American Academy of Pediatrics.

Gastrointestinal cytomegalovirus disease in renal transplant recipients: A case series

The purpose of this article was to report a series of 23 renal transplant recipients with histologically proven and immunohistochemically confirmed cytomegalovirus (CMV) lesions in the gastrointestinal tract (GIT) and to assess the risk factors associated with severe disease/mortality. CMV patients (n=23) were allocated into two groups: those who died (n=6) and those considered cured (n=17). Overall mortality rate was 26% (6/23). Initial symptoms suggestive of lower GIT involvement were observed in all death cases and in 35.3% of those cured (p=0.01). Enterorrhagia was seen in 83.3% of the patients who died. Death risk increased twofold (RR 2 [1.13-3.52], p=0.01) when symptoms of lower GIT involvement were initially observed and sixfold when enterrohagia was present (RR 6 [1.1-35.9], p=0.001). Among death cases, mean time at diagnosis was significantly more distant (2002±2.9×2008±1.6, p=0.04). The difference in mortality rates seen as service practices changed along the years demonstrates the importance of early diagnosis. © 2011 John Wiley & Sons A/S.

Necrotizing soft tissue infection of the breast: Case report and literature review

Background: Necrotizing soft tissue infection (NSTI) is characterized by progressive infectious gangrene of the skin and subcutaneous tissue. Its treatment involves intensive care, broad-spectrum antibiotic therapy, and full debridement. Methods: We present two cases of NSTI of the breast, adding these cases to the 14 described in the literature, reviewing the characteristics and evolution of all cases. Case Report: On the fourth day after mastectomy, a 59-year-old woman with ulcerated breast cancer developed Type I NSTI caused by Pseudomonas aeruginosa, which had a favorable evolution after debridement and broad-spectrum antibiotics. The second patient was a 57-year-old woman submitted to a mastectomy and axillary dissection, who had recurrent seromas. On the 32nd post-operative day, after a seroma puncture, she developed Type II NSTI caused by β-hemolytic streptococci. She developed sepsis and died on the tenth day after debridement, intensive care, and broad-spectrum antibiotics. The cases are the first description of breast NSTI after mammary seroma aspiration and the first report of this condition caused by P. aeruginosa. Conclusion: Necrotizing soft tissue infection is rare in breast tissue. It frequently is of Type II, occurring mainly after procedures in patients with breast cancer. The surgeon's participation in controlling the focus of the infection is of fundamental importance, and just as important are broad-spectrum antibiotic therapy and support measures, such as maintenance of volume, correction of electrolytic disorders, and treatment of sepsis and septic shock. Once the infection has been brought under control, skin grafting or soft tissue flaps can be considered. The mortality rate in breast NSTI is 18.7%, all deaths being in patients with the fulminant Type II form. Surgical oncologists need to be alert to the possibility of this rare condition. © 2012, Mary Ann Liebert, Inc.

Multiple brain abscess from dental origin: Case report and literature review

Background: Brain abscess of dental origin is a rare situation and deserves attention due to its high mortality rate even when adequate treatment is done. Few reports are available when dental origin is the main cause of this infection. Case report: We present the case of a 70-year-old man diagnosed with cerebral abscess caused by apical lesions located at superior and inferior teeth. The three lesions containing pus were drained from anterior and posterior brain region and the laboratory evaluation revealed the presence of Streptococcus viridians and Bacteroides. Postoperative period was uneventful with excellent recovery after 1 year of surgery. Final diagnosis was able to be done due to excellent image exams availability like computer tomography and magnetic resonance using diffusion and perfusion techniques. Discussion: The early detection of this pathology with the correct diagnosis essential to give the patient the best treatment including antimicrobial drugs and drainage is of extreme importance. © 2011 Springer-Verlag.

Proactive management of extreme prematurity: Disagreement between obstetricians and neonatologists

Objective: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death.Study Design: Prospective cohort of 484 infants with 23 0/7 to 266/7 weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of ≥1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life.Result: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/neonatal clinical conditions.Conclusion: In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day. © 2012 Nature America, Inc.

Concentração letal LC50 do extrato aquoso de folhas de terminalia catappa em guaru, phalloceros caudimaculatus

This trial was conducted in order to determine the 50% lethal concentration (LC (I) 50-96h) of the aqueous extract of dried leaves of Terminalia catappa, a plant with antifungal, antibacterial and antiparasitic activity. Due to the increasing use of herbal medicines in aquaculture, its use is an option for controlling diseases in fish. Toxicity tests are important before recommending any treatment, since some products have therapeutic concentration close to lethal. To conduct the study used 135 fish species Guarus (Phalloceros caudimaculatus), exposed to increasing concentrations of: 0.0, 50.0, 100.0, 150.0, 200.0, 250.0, 300.0 mL of stock solution per liter of water. The results were calculated by the method Trimmed Spearman Karbo, demonstrating that the 50% lethal concentration (LC (I) 50-96h) estimated was 208.52 mL / L, with lower limit of 187.79 mL / L and higher 231.54 mL / L. Observed changes in behavior of the test organisms at concentrations above 250 mL / L decrease in the levels of dissolved oxygen and pH. Concentrations below 250 mL /L result in mortality rate near zero, so the aqueous extract shown low toxicity.

Doxorubicin induced dilated cardiomyopathy in a rabbit model: An update

Dilated cardiomyopathy (DCM) is characterized by chamber dilation and cardiac dysfunction. Because of the poor prognosis, models are needed for the investigation of and development of new therapeutic approaches, as well as stem cell therapy. Doxorubicin (DOX), used as chemotherapeutic agent, is reported to be cumulative cardiotoxic causing DCM. The aim of the study was to investigate the onset of systolic dysfunction using echocardiography in rabbits receiving two different doses of DOX (1. mg/kg twice a week and 2. mg/kg once a week). Twenty rabbits were treated with doxorubicin in two different doses for 6. weeks and compared with a control group treated with NaCl 0.9%. The effect of doxorubicin on the myocardium was investigated with histological analysis and scanning electron microscopy of left ventricle (LV), as well as in the interventricular septum (IVS) and right ventricle (RV). The results showed a high mortality rate for rabbits receiving 2. mg/kg once a week. A significant reduction in systolic function was present in animals treated with DOX after 6. weeks, with decreased ejection fraction and shortening fraction. Histology and electron microscopy revealed vacuolization, intracytoplasmic granulation, necrosis and interstitial fibrosis in LV, as well as in the IVS and RV. Doxorubicin induced changes are present in the LV, RV and IVS, and the administration at the dose of 1. mg/kg twice a week for only 6. weeks is safe and sufficient to induce DCM in rabbits. © 2012 Elsevier Ltd.

Does background colouration affect the behaviour of tadpoles? An experimental approach with an odonate predator

Predation is a primary driver of tadpole assemblages, and the activity rate is a good predictor of the tadpoles' tolerance for predation risk. The conflicting demands between activity and exposure to predation can generate suboptimal behaviours. Because morphological components, such as body colouration, may affect the activity of tadpoles, we predict that environmental features that enhance or match the tadpole colouration should affect their survival or activity rate in the presence of a predator. We tested this prediction experimentally by assessing the mortality rate of tadpoles of Rhinella schneideri and Eupemphix nattereri and the active time on two artificial background types: one bright-coloured and one black-coloured. We found no difference in tadpole mortality due to the background type. However, R. schneideri tadpoles were more active than E. nattereri tadpoles, and the activity of R. schneideri was reduced less in the presence of the predator than that of E. nattereri. Although the background colouration did not affect the tadpole mortality rate, it was a stimulus that elicited behavioural responses in the tadpoles, leading them to adjust their activity rate to the type of background colour. © 2013 Dipartimento di Biologia, Università degli Studi di Firenze, Italia.

Performance, survivability and carcass traits of crossbred lambs from five paternal breeds with local hair breed Santa Inês ewes

The present study aimed to evaluate the performance, survivability and carcass traits of crossbred lambs. Data from 299 lambs born to 209 ewes were used. The dams were from a local hair breed (Santa Inês) and five breeds of sires were used: Dorper (DR), Ile de France (IF), Hampshire Down (HD), Texel (TX) and Santa Inês (SI). The lambs were weighed at birth, weaning and slaughter. Fasting body weight, skin thickness, hot and cold carcass weight, carcass yield and carcass length were measured at slaughter. Carcasses were separated into commercial cuts: neck, shoulder, rib, belly, loin and leg. Leg length and circumference were measured. Analyses of variances using MIXED procedure in SAS® were carried out for weights and carcass traits. Factor, discriminant and canonical analysis were carried out. Mortality data of animals from birth until slaughter was analyzed using logistic regression. The HD animals had the highest mortality rate. TX lambs had similar growth rate and survivability compared to DR and IF and had better carcass traits than these genetic groups. Therefore, this breed can be used as paternal breed to crossbreeding with Santa Inês dams. Santa Inês animals did not differ in growth from birth until slaughter compared to crossbred animals, which highlights the potential of this naturalized breed for meat production. Moreover, there is a great variability inside this breed for carcass and growth traits which may undergo great improvement through selection programs. © 2013 Elsevier B.V.

Dairy goat health management and milk production on organic and conventional system in Brazil

The aimed of this article is to measure risk factors on health and milk production on organic and conventional dairy goats in Brazil. Two experimental groups (organic and conventional) were evaluated simultaneously. The study design was completely randomized. The organic herd consisted of 25 goats and 15 kids. In the conventional production system, a dairy herd comprising 40 goats and 20 kids participated in the study. Data on milk production and health management were available from January 2007 to December 2009. The abortion rate in the conventional system was 5% (2/40) whereas in organic system no abortion was diagnosed (0/25). The mortality rate at weaning in the conventional system was 5% (2/40) and in the organic system was 8% (2/25). Milk production was lower (2.20 kg/day) in organic than conventional system (2.66 kg/day). Goats and kids in organic farm had a higher FEC (386±104 and 900±204, respectively) (p<0.05) than those in conventional farm (245±132 and 634±212, respectively). In addition, Saanen kids had higher FEC (p<0.001) than goats. Treatment with antiparasitic drugs was higher in conventional system (50%) than organic system (1.3%).

A randomized clinical trial of high volume peritoneal dialysis versus extended daily hemodialysis for acute kidney injury patients

Background: Acute kidney injury (AKI) requiring dialysis in critically ill patients is associated with an in-hospital mortality rate of 50-80 %. Extended daily hemodialysis (EHD) and high volume peritoneal dialysis (HVPD) have emerged as alternative modalities. Methods: A double-center, randomized, controlled trial was conducted comparing EHD versus HVPD for the treatment for AKI in the intensive care unit (ICU). Four hundred and seven patients were randomized and 143 patients were analyzed. Principal outcome measure was hospital mortality, and secondary end points were recovery of renal function and metabolic and fluid control. Results: There was no difference between the two groups in relation to median ICU stay [11 (5.7-20) vs. 9 (5.7-19)], recovery of kidney function (26.9 vs. 29.6 %, p = 0.11), need for chronic dialysis (9.7 vs. 6.5 %, p = 0.23), and hospital mortality (63.4 vs. 63.9 %, p = 0.94). The groups were different in metabolic and fluid control. Blood urea nitrogen (BUN), creatinine, and bicarbonate levels were stabilized faster in EHD group than in HVPD group. Delivered Kt/V and ultrafiltration were higher in EHD group. Despite randomization, there were significant differences between the groups in some covariates, including age, pre-dialysis BUN, and creatinine levels, biased in favor of the EHD. Using logistic regression to adjust for the imbalances in group assignment, the odds of death associated with HVPD was 1.4 (95 % CI 0.7-2.4, p = 0.19). A detailed investigation of the randomization process failed to explain the marked differences in patient assignment. Conclusions: Despite faster metabolic control and higher dialysis dose and ultrafiltration with EHD, this study provides no evidence of a survival benefit of EHD compared with HVPD. The limitations of this study were that the results were not presented according to the intention to treat and it did not control other supportive management strategies as nutrition support and timing of dialysis initiation that might influence outcomes in AKI. © 2012 Springer Science+Business Media Dordrecht.

Temporal polyethism and life expectancy of workers in the eusocial wasp polistes canadensis canadensis Linnaeus (Hymenoptera: Vespidae)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Stocking density of Nile tilapia in cages placed in a hydroelectric reservoir

The Brazilian government has been encouraging fish farming in cages in federal water bodies, including hydroelectric reservoirs. Despite the government support, it is a new activity and the production model still needs some adjustment to reduce the production costs and achieve sustainability. The aims of this study were to determine the appropriate stocking density of Nile tilapia in cages in a hydroelectric reservoir and to evaluate to what extent fish size selection could improve their uniformity. Twelve cages (6m3) were placed at the Fish Farmers' Cooperative of Santa Fé do Sul and Region, Ilha Solteira reservoir, São Paulo, Brazil (20°12'10″S, 50°58'31.15″W). In stage I (initial fish weight, 78g), four stocking densities were tested: D1-800, D2-2000, D3-2500 and D4-3000 fish/cage, with three replicates. At the end of this stage (average fish weight, 255g), the fish were selected into three sizes, except for D1. In stage II, four stocking densities were tested, designed to obtain the following final production: D1-100kg/m3 (800 non-selected fish/cage), D2-80kg/m3 (600 fish/cage), D3-100kg/m3 (800 fish/cage) and D4-120kg/m3 (900 fish/cage). The trial ended when the fish weighed 800g. By reducing the initial stocking density from 2500 to 800 tilapia juveniles per cage, there was no need for selection. The growth performance was higher, the feed conversion rate was better and the time taken to reach harvesting was shorter. Consequently, the production cost reduced and the operating profit increased. Using the lowest initial stocking density, the risk of disease outbreak was also lower, and there was no need to use drugs for disease control since the mortality rate and occurrences of disease and deformity decreased and the dissolved oxygen level inside the cages was higher. © 2013 Elsevier B.V.

Produção de juvenis de Pseudoplatystoma coruscans (Agassiz, 1829) com dietas vivas e formuladas

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)